Pennsylvania Mountains Healthcare Alliance (PMHA) is seeking a Contracting and Payer Relations Specialist.   

Overview

PMHA is seeking a Contracting and Payer Relations Specialist to support our Director of Contracting and Payer Relations and VP of Revenue Cycle in managing payer relationships and contract performance across our network of member hospitals.  This role plays an important part in the analysis, administration, and lifecycle management of payer contracts, helping ensure accurate reimbursement and effective collaboration between healthcare providers and insurance payers.  Primary scope of work includes hospitals, hospital-based physicians, physician practices, and ancillary provider payor contracts including commercial, managed Medicare and managed Medicaid lines of business.  The position works closely with hospital leadership, internal departments, and payer organizations to analyze payment trends, resolve reimbursement issues, and educate and support hospital staff.

Key Responsibilities

Payer Contract Management

• Support the full lifecycle of payer contracts, assist in maintaining fee and rate schedules, and monitor contract compliance

Payment Analysis & Issue Resolution

• Investigate payment discrepancies and reimbursement issues, identify root cause, and monitor payment accuracy and performance metrics

Payer & Provider Collaboration

• Build and maintain productive relationships with payer organizations and participating hospitals, coordinate payer meetings, and communicate policy updates and changes

Reporting & Analytics

• Prepare reports and data analyses, assist leadership with data requests, and support implementation and use of contract management tools

Process Improvement

• Identify opportunities to improve contract management processes, assist in organization and documentation, and support development of standardized materials

Qualifications

The ideal candidate will possess the following minimum qualifications:

·         BS or BA in Health Administration, Health Management, Finance, Accounting, or related field required

·         3 years’ experience in healthcare contracts, revenue cycle, patient access, payer relations, or finance required

·         Proficiency in Microsoft Office Suite applications is required

·         A commitment to excellent customer service

The ideal candidate will also possess the following:

·         Working knowledge of contractual, health insurance, and operational issues related to healthcare delivery

·         Working knowledge of healthcare claims, provider, eligibility, and quality/value-based care data

·         Understanding of managed care metrics

·         Critical thinking and problem-solving skills

Interested candidates can contact us and submit a resume.